Lower Back Pain (Lumbar Spine Pain)

Lower back pain may be serious if the pain lasts for over a week, radiates to other parts of the body, or is accompanied by other symptoms

To understand various causes of low back pain, it is important to appreciate the normal design (anatomy) of the tissues of this area of the body. Important structures of the low back that can be related to symptoms in this region include the bony lumbar spine (vertebrae, singular = vertebra), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

The bony lumbar spine is designed so vertebrae "stacked" together provide a movable support structure while also protecting the spinal cord from injury. The spinal cord is composed of nervous tissue that extends down the spinal column from the brain. Each vertebra has a spinous process, a bony prominence behind the spinal cord, which shields the cord's nervous tissue from impact trauma. Vertebrae also have a strong bony "body" (vertebral body) in front of the spinal cord to provide a platform suitable for weight-bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone that is situated in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joints of the buttocks.

The discs are pads that serve as "cushions" between the individual vertebral bodies. They help minimize the impact of stress forces on the spinal column. Each disc is designed like a jelly donut with a central, softer component (nucleus pulposus) and a surrounding, firm outer ring (annulus fibrosus). The central portion of the disc is capable of rupturing (herniating, as in a herniated disc) through the outer ring, irritating adjacent nervous tissue and sciatica as described below. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae to each other and surround each of the discs.

The nerves that provide sensation and stimulate the muscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes) all exit the lumbar spinal column through bony portals, each of which is called a "foramen."

Many muscle groups that are responsible for flexing, extending and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.

The aorta and blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine in the abdomen and pelvis. Surrounding these blood vessels are lymph nodes (lymph glands) and tissues of the involuntary nervous system that are important in maintaining bladder and bowel control.

The uterus and ovaries are important pelvic structures in front of the pelvic area of women. The prostate gland is a significant pelvic structure in men. The kidneys are on either side of the back of the lower abdomen, in front of the lumbar spine.

The skin over the lumbar area is supplied by nerves that come from nerve roots that exit from the lumbar spine.

The low back, or lumbar area, serves several important functions for the human body. These functions include structural support, movement, and protection of certain body tissues.

When we stand, the lower back is functioning to support the weight of the upper body. When we bend, extend, or rotate at the waist, the lower back is involved in the movement. Therefore, injury to the structures important for weight-bearing, such as the bony spine, muscles, tendons, and ligaments, often can be detected when the body is standing erect or used in various movements.

Protecting the soft tissues of the nervous system and spinal cord as well as nearby organs of the pelvis and abdomen is a critical function of the lumbar spine and adjacent muscles of the low back.

Common causes of low back pain (lumbar backache) include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints.

Lumbar strain (acute, chronic): A lumbar strain is a stretch injury to the ligaments, tendons, and/or muscles of the low back. A stretching incident can result in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly classified as "acute" if it has been present for days to weeks. If the strain lasts longer than three months, it is referred to as "chronic." Lumbar strain most often occurs in people in their 40s, but it can happen at any age. The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stresses the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back. The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, X-ray testing is only helpful to exclude bone abnormalities.

The treatment of lumbar strain consists of resting the back to avoid reinjury, medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Initial treatment at home might include heat application, acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), and avoiding reinjury and heavy lifting. Prescription medications that may be used for acute low back pain include nonsteroidal anti-inflammatory medications, such as sulindac (Clinoril), naproxen (Naprosyn), and ketorolac (Toradol) by injection or by mouth, muscle relaxants, such as carisoprodol (Soma), cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and metaxalone (Skelaxin), as well as analgesics, such as tramadol (Ultram).

Long periods of inactivity in bed are not recommended, as this may slow recovery. Spinal manipulation for periods of up to one month is helpful in some patients who do not have signs of nerve irritation. Future injury may be avoided by using back-protection techniques during activities and support devices as needed at home or work.

Nerve irritation: The nerves of the lumbar spine can be irritated by mechanical pressure (impingement) by bone or other tissues, or from disease, anywhere along their paths -- from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles).

Lumbar radiculopathy: Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration ("wear and tear") of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized "sciatica" pain of a herniated disc that shoots from the low back and buttock down the leg. A history of localized low-back aching can precede sciatica, or it can follow a "popping" sensation and be accompanied by numbness and tingling. The back pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels. The sciatica of lumbar radiculopathy typically affects only one side of the body, such as the left side or right side, and not both. Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating back pain when the lower extremity is lifted supports the diagnosis. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation. The actual disc herniation can be detected with imaging tests, such as CAT or MRI scanning. Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscle spasms, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage therapy, ultrasound, exercises, electrical stimulation), and rest (not strict bed rest but avoiding reinjury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

Bony encroachment: Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body, commonly as a result of arthritis), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause lower-extremity pains that worsen with walking and are relieved by resting (mimicking the pains of poor circulation). Treatment of these afflictions varies, depending on their severity, and ranges from rest and exercises to epidural cortisone injections and surgical decompression by removing the bone that is compressing the nervous tissue.

Bone and joint conditions: Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are due to inflammation of the joints (arthritis).

Congenital bone conditions: Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal architecture of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit from support bracing. Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with the absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.

Degenerative bone and joint conditions: As we age, the water and protein content of the body's cartilage changes, resulting in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on X-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain X-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasms, and inflammation.

Injury to the bones and joints: Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor-vehicle accidents or a convulsive seizure.

In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty or kyphoplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methylmethacrylate) is injected into the balloon and remains to retain the structure and height of the body of the vertebra. Pain is relieved as the height of the collapsed vertebra is restored.

Arthritis: The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing inflammation. Newer biological medications have been greatly successful in both quieting the disease and stopping its progression.

Other causes of low back pain include kidney problems, pregnancy, ovary problems, and tumors.

Kidney problems

Kidney infections, stones, and traumatic bleeding of the kidney (hematoma) are frequently associated with low back pain. Diagnosis can involve urine analysis, sound-wave tests (ultrasound), or other imaging studies of the abdomen.

Pregnancy

Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to the loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are often recommended for relieving this pain. Women are also advised to maintain physical conditioning during pregnancy according to their doctors' advice. Natural labor can also cause low back pain.

Ovary problems

Ovarian cysts, uterine fibroids, and endometriosis may also cause low back pain. Precise diagnosis can require gynecologic examination and testing.

Tumors

Low back pain can be caused by tumors, either benign (non-cancerous) or malignant (cancerous), that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastatic tumors). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using imaging tests, such as plain X-rays, nuclear bone scanning, and CAT and MRI scanning.

Uncommon causes of low back pain include Paget's disease of bone, bleeding or infection in the pelvis, infection of the cartilage and/or bone of the spine, aortic aneurysm, and shingles.

Paget's disease of bone

Paget's disease of the bone is a condition of unknown cause in which the bone formation is out of synch with normal bone remodeling. This condition results in abnormally weakened bone and deformity and can cause localized bone pain, though it often causes no symptoms. Paget's disease is more common in people over age 50. Heredity (genetic background) and certain unusual viral infections have been suggested as causes. Thickening of involved bony areas of the lumbar spine can cause the radiating lower extremity pain of sciatica.

Paget's disease can be diagnosed on plain X-rays. However, a bone biopsy is occasionally necessary to ensure the accuracy of the diagnosis. Bone scanning is helpful to determine the extent of the disease, which can involve more than one bone area. A blood test, alkaline phosphatase, is useful for diagnosis and monitoring response to therapy. Treatment options include aspirin, other anti-inflammatory medicines, pain medications, and medications that slow the rate of bone turnover, such as calcitonin (Calcimar, Miacalcin), etidronate (Didronel), alendronate (Fosamax), risedronate (Actonel), and pamidronate (Aredia).

Bleeding or infection in the pelvis

Bleeding in the pelvis is rare without significant trauma and is usually seen in patients who are taking blood-thinning medications, such as warfarin (Coumadin). In these patients, rapid-onset sciatica pain can be a sign of bleeding in the back of the pelvis and abdomen that is compressing the spinal nerves as they exit to the lower extremities. Infection of the pelvis is infrequent but can be a complication of conditions such as diverticulosis, Crohn's disease, ulcerative colitis, pelvic inflammatory disease with infection of the Fallopian tubes or uterus, and even appendicitis. Pelvic infection is a serious complication of these conditions and is often associated with fever, lowered blood pressure, and a life-threatening state.

Infection of the cartilage and/or bone of the spine

Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is called Pott's disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in raw goat's milk.

Aortic aneurysm

In the elderly, atherosclerosis can cause the weakening of the wall of the large arterial blood vessel (aorta) in the abdomen. This weakening can lead to a bulging (aneurysm) of the aorta wall. While most aneurysms cause no symptoms, some cause pulsating low back pain. Aneurysms of a certain size, especially when enlarging over time, can require surgical repair with a grafting procedure to repair the abnormal portion of the artery.

Shingles

Shingles (herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with more chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax), for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain.

Risk factors for low back pain include athletic activity, heavy lifting, throwing, moving luggage, traumatic injury, kidney infection, pregnancy, osteoporosis, and aging.

Low back pain can cause a wide variety of symptoms and signs depending on the cause of the back pain. Symptoms that can be associated with low back pain include numbness and/or tingling of the lower extremities, incontinence of urine or stool, inability to walk without worsening pain, lower extremity weakness, atrophy (decreased size) of the lower extremity muscles, rash, fever, chills, weight loss, abdominal pains, burning on urination, dizziness, joint pain, and fatigue.

Physician specialties that evaluate and treat low back pain range from generalists to subspecialists. These specialties include emergency medicine physicians, general medicine, family medicine, internal medicine, gynecology, spine surgeons (orthopaedics and neurosurgery), rheumatology, pain management, and physiatry.

Other health care providers for low back pain include physical therapists, chiropractors, massage therapists, psychologists, and acupuncturists.

The diagnosis of low back pain involves a review of the history of the illness and underlying medical conditions as well as a physical examination. A complete story of the back pain must be reviewed including injury history, aggravating and alleviating conditions, associated pain symptoms (fever, numbness, tingling, incontinence, etc.), as well as the duration and progression of symptoms. Aside from routine abdomen and extremity evaluations, rectal and pelvic examinations may eventually be required as well. Further tests for diagnosis of low back pain can be required including blood and urine tests, plain film X-ray tests, CAT scanning, MRI scanning, bone scanning, and tests of the nerves such as electromyograms (EMG) and nerve conduction velocities (NCV).

As described above, the treatment for lower back pain depends upon the cause. Each patient must be individually evaluated and managed in the context of the underlying background health status and activity level.

As has been highlighted by research presented at the national meeting of the American College of Rheumatology, a very important aspect of the individual evaluation is the patient's understanding and perception of their particular situation. British researchers found those who believed their symptoms or treatments had serious consequences on their lives, or who had little control over their symptoms were more likely to have a poor outcome. This research points out to physicians the importance of addressing the concerns and perceptions that patients have about their condition during the initial evaluations.

The conditions listed above are intended for general review. There are many other possible causes of back pain, including upper back pain, that have not been discussed.

Self-care remedies for pain relief include cold packs and heat applications, topical analgesic balms, avoiding reinjury, eliminating heavy lifting, and taking over-the-counter pain relievers such as acetaminophen (Tylenol), naproxen (Aleve), and ibuprofen (Advil, Motrin).

8 simple stretches to relieve lower back pain

1. Kneeling lunge stretch

• Begin with kneeling on both knees and bring one leg forward until the foot is level on the ground.
• Maintain equal distribution of weight across both hips (rather than on one side or the other).
• Lean forward with both hands on the top of the thigh to feel a stretch in the front of the opposite leg.
• This stretch affects the hip flexor muscles, which link to the pelvis and, if overly tight, can compromise posture.

2. Piriformis muscle stretch

• Lie on your back with your legs bent and heels flat on the floor.
• Cross one leg over the other, placing the ankle on the bent knee, and slowly draw the lower knee toward the chest until a stretch in the buttock is felt.
• Alternatively, lie on the floor and cross one leg over the other, pulling it forward over the torso at the knee while maintaining the other leg flat.

3. Cobra Stretch

• This technique can stretch tight abdominal muscles and the lower back.
• Begin by lying on your stomach, legs outstretched, palms placed on either side of your head, forearms, and elbows flat on the ground.
• Slowly raise your body such that your weight is supported on the forearms.
• Keep your hips firmly planted on the ground.
• Hold for 10 seconds until you have found a comfortable posture that gradually extends your abdominal muscles and lower back.
• Return to the starting position slowly and repeat five times.
• Straighten your arms if you have more flexibility in your lower back.

4. Restful or the child’s pose

• The calm child's pose, a basic yoga practice, can help you relax your body.
• Position yourself on your hands and knees on the floor, with your knees slightly wider than hip-distance apart.
• Bring your toes together and push your hips back, bending your knees.
• As you find a comfortable seating position, completely stretch your arms forward and allow your head to fall forward into a relaxed position.
• Hold this stance for 20 seconds before returning to the beginning position and repeat it three times more.
• If you experience shoulder pain, position your arms on each side of your body and stretch them toward your feet.

5. Seated spinal twist

• A simple sitting spinal twist might help with lower back discomfort.
• This position will help with flexibility.
• This easy stretch has several health advantages, including improved mood, knee, spinal, and shoulder flexibility.
• Sit on the floor, with legs straight out in front of you and arms behind your back.
• Place both hands on the floor behind you with your fingers facing away from you.
• Place your left foot flat on the ground on the outside of your right knee.
• Inhale and bring your right arm up.
• Exhale and pull your right arm down placing your elbow on the outside of your left leg.
• Turn your chest, head, and eyes to the left.
• Hold for about a minute. Breathe. Slowly bring your head and then your chest back to the center.
• Repeat on the other side.

6. Legs up on the wall

• Crawl your legs up and rest them on the wall while lying flat on your back with your buttocks flat on the wall.
• If your lower back muscles are sensitive to touch, rest on a folded towel or blanket for more support and cushioning.

7. Trunk rotations

• If your back stiffness stops you from rolling or rotating, this is an excellent stretch to help loosen things up.
• To begin with, lie on your back on the ground, legs facing up, hands behind your head, and elbows on the floor.
• Allow your legs to rotate toward the ground to one side while keeping your knees together.
• This stretch focuses on tight muscles in the lower and middle back.

8. Pelvic tilt

• This stretch is another basic exercise that efficiently relieves lower back muscular tension. This stretch increases the area's flexibility.
• Begin by laying on your back with your feet flat, knees bent, and arms at your sides. Because of the curvature of the spine, the lower back is somewhat raised.
• Gently arch your lower back and push your tummy out. This stance aids with core stability.
• Before relaxing, hold the posture for at least five seconds.
• Push the pelvis slightly upward while remaining on the floor. Tighten the muscles in your glutes and abdomen.
• The lower back should be placed on the floor.
• Before relaxing, hold the posture for at least five seconds. Repeat the exercise every day. Start with 10 to 15 repetitions and slowly build it up to 25 to 30.

8 exercises to avoid with lower back pain

1. Leg lifts/Double leg raises

• Here the person lifts both legs together while lying on their back touching the ground.
• Since it requires a strong core to carry out this exercise, which puts immense pressure on the back, it should be avoided.

2. Sit-ups

• A core strengthening exercise where most people use their hips to carry their body weight, which creates an increased tension on the spine and aggravates back pain.

3. Standing toe touches

• Here the person stands straight and tries to touch their toe by bending forward.
• Because it causes increased extension of the lower back, it increases the risk of stress to the disks and ligaments there. Hence, it should be avoided.

4. Abdominal crunches

• Here the person lies on the ground on their back and bends their knee in the right angle position. Then the person tries to lift their torso and come closer to the knee as much as possible.
• This again hyperextends the spine and ligaments involved, so it should be avoided.

5. Back squats

• These are a modification of the traditional squats where the person puts an iron bar carrying heavy weights on their back and performs the squats.
• People with back pain should completely avoid carrying weights, so this exercise should be avoided.

6. Superman back extensions

• You begin by lying on the ground facing down, which you then simultaneously lift your arms and legs off the ground and try to hold this position up.
• This position involves the muscles of the core and back and creates the highest amount of stress. Thus, it must be completely skipped by people who experience even slight lower back pain.

7. Exercises involving overhead or shoulder lifting of weights

• Lifting weights when you have lower back pain puts excessive stress over the spine and back muscles and increases the risk of muscle spasms and ligament tears. Thus, these exercises should not be performed.

8. Avoid skipping warm-ups

• This is a very common mistake done by people while working out. Doing warm-up exercises, such as a cat-cow position in yoga, stretches the lower back muscles and prepares them for the workout ahead.
• Skipping these warm-ups creates an additional risk of spontaneous injury to the muscles and ligaments of the body.

When should I be worried about lower back pain?

1. Pain for over a week: In most cases, back pain resolves within a few days. If the pain persists for more than a week, it may be time to see a doctor. Your doctor will perform tests to help determine the cause of your pain before it becomes a bigger problem. As with many other health issues, early treatment is critical.
2. Pain radiating to other parts of the body: If your back pain is accompanied by shooting pain down the leg or pain in other areas of the body, seek medical attention. This could be an indication of sciatica, a type of pain that affects the sciatic nerve, which runs from the lower back down the buttocks and down each leg. Sciatica is often caused by a herniated disc.
3. Pain following an injury: If your back pain is caused by a car accident, fall, or other type of injury, it may indicate a serious issue such as a fracture that needs to be addressed.
4. Pain accompanied by pins and needles, numbness, or weakness: Back discomfort accompanied by numbness, tingling, or weakness could indicate nerve irritation or injury. This is especially true if the discomfort persists after taking over-the-counter pain medicines. Nerve discomfort is dangerous and, if left untreated, can result in lifelong damage or disability.
5. Worsening of pain with certain positions or during a certain time frame: Sometimes, significant back pain may occur only in certain positions or wake you up in the middle of the night. This could be an indication of a more serious problem such as an infection, fracture, severe nerve compression, or even malignancy (cancer).
6. Pain with bowel movements or urination: If your lower back pain is accompanied by lack of control over your bowel movements or urination, you should seek immediate medical attention. This could be a sign of cauda equina syndrome, in which the nerves in the lower spine have been compressed. Although a rare condition, if left untreated, it can cause lifelong nerve damage that requires surgery to decompress the nerves and regain their function.
7. Pain with fever: Lower back pain can sometimes be accompanied by fever if you have the flu or another infection. However, if your fever does not respond to over-the-counter treatments, it may indicate a dangerous infection that requires emergency medical care. Consulting a doctor is necessary to identify the cause and take appropriate medications (antibiotics) in case of an infection.
8. Unintentional weight loss: If you experienced unexplained weight loss along with your lower back pain, consult a doctor to rule out more serious conditions such as an infection or tumor.

The outlook for low back pain depends on its precise cause. For example, acute strain injuries generally heal entirely with minimal treatment. On the other hand, bony abnormalities that irritate the spinal cord can require significant surgical repair and the outlook depends on the surgical result. Long-term optimal results often involve exercise rehabilitation programs that can involve physical therapists.

Avoiding injury to the low back is a method of preventing low back pain. Additionally, conditioning exercise programs designed to strengthen the lumbar area and adjacent tissues can help to minimize the risk of injury to the low back. Specific programs to relieve and prevent back pain can be designed with the help of physical therapists and other treating health care professionals.